monthly rates for individuals and families

Transcription

1 monthly rates for individuals and families Find your rate: 1. Find your county of residence and its corresponding rating region. Go to that rating region page. 2. Find your selected plan for you and/or your family in the chart. 3. Locate the rating category (e.g. adult and child) and age range that applies to you, the primary applicant. The rates in this brochure are Blue s Tier 1 rates, and are offered to individuals and families in good health. Other rates may apply depending on underwriting determination. If you apply for coverage for your child at any time other than during a special enrollment period, and your child did not maintain health coverage during the 90-day period prior to the signature date of the application, a 20% surcharge will apply for the first 12 months of coverage. For additional information, visit blueshieldca.com/children. Rating regions and rates are subject to change. Dental coverage and individual term life rates can be found on pages 5. Effective March 1, 2013

2 rating regions by county County Zip codes Region Alameda Except ZIP codes listed below 4 Alameda ZIP codes 95377, Alpine 1 Amador 3 Butte Except ZIP codes listed below 1 Butte ZIP codes 95901, Calaveras Except ZIP codes listed below 3 Calaveras ZIP codes 95230, Colusa Except ZIP codes listed below 1 Colusa ZIP code Colusa ZIP code Contra Costa 4 Del Norte 1 El Dorado Except ZIP code listed below 6 El Dorado ZIP code Fresno Except ZIP code listed below 3 Fresno ZIP code Glenn Except ZIP codes listed below 3 Glenn ZIP code Humboldt 1 Imperial Except ZIP codes listed below 1 Imperial ZIP code Imperial ZIP codes 92225, Inyo 1 Kern Except ZIP codes listed below 1 Kern ZIP codes 93536, Kings Except ZIP codes listed below 1 Kings ZIP codes 93242, 93631, Lake 6 Lassen Except ZIP codes listed below 6 Lassen ZIP code Lassen ZIP code Los Angeles Except ZIP codes listed below 9 Los Angeles ZIP codes 93243, County Zip codes Region Los Angeles ZIP codes 90247, 90248, 90249, , 90251, 90260, 90261, 90274, 90275, 905-, 906-, 907-, 908-, 910-, 911-, 912-, 915-, 917-, 918-, 93510, 93532, 93535, 93536, 93539, 93543, 93544, 93550, 93551, 93552, 93553, 93563, 93584, 93586, 93590, 93591, Madera Except ZIP codes listed below 1 Madera ZIP codes 93602, 93620, 93622, , Madera ZIP code Marin 5 Mariposa Except ZIP codes listed below 6 Mariposa ZIP codes 93601, 93653, Mariposa ZIP code Mendocino 1 Merced Except ZIP codes listed below 3 Merced ZIP code 93610, Modoc Except ZIP codes listed below 3 Modoc ZIP code Modoc ZIP code Mono Except ZIP code listed below 5 Mono ZIP code Monterey Except ZIP codes listed below 5 Monterey ZIP code Monterey ZIP code Napa Except ZIP code listed below 6 Napa ZIP code Nevada 3 Orange Except ZIP codes listed below 7 Orange ZIP codes beginning with Placer Except ZIP codes listed below 3 Placer ZIP codes 95668, Plumas Except ZIP code listed below 1 Plumas ZIP code March 2013 Monthly Rates for Individuals and Families

3 rating regions by county County Zip codes Region Riverside Except ZIP codes listed below 7 Riverside ZIP codes 92201, 92202, 92203, , 92211, 92220, 92223, 92225, 92226, 92230, 92234, 92235, 92236, 92239, 92240, 92241, 92247, 92253, 92254, 92255, 92258, 92260, 92261, 92262, 92263, 92264, 92270, 92274, 92276, 92282, 92292, 92860, 92880, Riverside ZIP code Sacramento Except ZIP code listed below 3 Sacramento ZIP code San Benito Except ZIP codes listed below 1 San Benito ZIP code San Benito ZIP codes 93930, San Bernardino Except ZIP codes listed below 7 San Bernardino ZIP codes 93516, San Bernardino ZIP code San Diego 2 San Francisco 5 San Joaquin Except ZIP codes listed below 1 San Joaquin ZIP codes 95632, San Joaquin ZIP codes 94505, San Luis Obispo Except ZIP code listed below 1 San Luis Obispo ZIP code San Mateo 5 Santa Barbara 1 Santa Clara Except ZIP codes listed below 4 Santa Clara ZIP code Santa Clara ZIP codes beginning with , 943- Santa Clara ZIP codes 95033, Santa Cruz 6 Shasta Except ZIP codes listed below 3 Shasta ZIP code Shasta ZIP codes 96056, County Zip codes Region Sierra Except ZIP codes listed below 3 Sierra ZIP code Sierra ZIP code Siskiyou 1 Solano Except ZIP codes listed below 6 Solano ZIP codes 95616, 95618, , Sonoma Except ZIP code listed below 1 Sonoma ZIP code Stanislaus Except ZIP code listed below 1 Stanislaus ZIP code Sutter Except ZIP codes listed below 6 Sutter ZIP codes 95626, 95645, 95648, , Sutter ZIP code Tehama Except ZIP codes listed below 6 Tehama ZIP codes 95963, 96022, Tehama ZIP code Trinity Except ZIP code listed below 1 Trinity ZIP code Tulare Except ZIP codes listed below 3 Tulare ZIP codes 93212, 93215, , Tuolumne Except ZIP codes listed below 3 Tuolumne ZIP codes 95230, Tuolumne ZIP code Ventura Except ZIP codes listed below 7 Ventura ZIP codes 93013, Ventura ZIP code 90265, and ZIP codes 9 beginning with 913- Yolo Except ZIP code listed below 3 Yolo ZIP code Yuba Except ZIP codes listed below 6 Yuba ZIP codes 95914, 95941, Yuba ZIP codes 95960, March 2013 Monthly Rates for Individuals and Families 3

4 rating regions by county County Zip codes Region Alameda Except ZIP codes listed below 4 Alameda ZIP codes 95377, Butte Except ZIP codes listed below 1 Butte ZIP codes 95901, Contra Costa 4 El Dorado* 6 Fresno Except ZIP code listed below 3 Fresno ZIP code Kern* Except ZIP codes listed below 1 Kern* ZIP codes 93536, Kings Except ZIP codes listed below 1 Kings ZIP codes 93242, 93631, Los Angeles Except ZIP codes listed below 9 Los Angeles ZIP codes 93243, Los Angeles ZIP codes 90247, 90248, 90249, , 90251, 90260, 90261, 90274, 90275, 905-, 906-, 907-, 908-, 910-, 911-, 912-, 915-, 917-, 918-, 93510, 93532, 93535, 93536, 93539, 93543, 93544, 93550, 93551, 93552, 93553, 93563, 93584, 93586, 93590, 93591, Madera Except ZIP codes listed below 1 Madera ZIP codes 93602, 93620, 93622, , Madera ZIP code Marin 5 Merced Except ZIP codes listed below 3 Merced ZIP code 93610, Nevada* 3 Orange Except ZIP codes listed below 7 Orange ZIP codes beginning with Placer* 3 Riverside Except ZIP codes listed below 7 Riverside ZIP codes 92201, 92202, 92203, 92210, 92211, 92220, 92223, 92225, 92226, 92230, 92234, 92235, 92236, 92239, 92240, 92241, 92247, 92253, 92254, 92255, 92258, 92260, 92261, 92262, 92263, 92264, 92270, 92274, 92276, 92282, 92292, 92860, 92880, County Zip codes Region Riverside ZIP code Sacramento Except ZIP code listed below 3 Sacramento ZIP code San Bernardino* Except ZIP codes listed below 7 San Bernardino* ZIP code San Bernardino* ZIP code San Diego* 2 San Francisco 5 San Joaquin Except ZIP codes listed below 1 San Joaquin ZIP codes 95632, San Joaquin ZIP codes 94505, San Luis Obispo Except ZIP code listed below 1 San Luis Obispo ZIP code San Mateo 5 Santa Barbara 1 Santa Clara Except ZIP codes listed below 4 Santa Clara ZIP code Santa Clara ZIP codes beginning with , 943- Santa Clara ZIP codes 95033, Santa Cruz 6 Solano Except ZIP codes listed below 6 Solano ZIP codes 95616, 95618, , Sonoma Except ZIP code listed below 1 Sonoma ZIP code Stanislaus Except ZIP code listed below 1 Stanislaus ZIP code Tulare Except ZIP codes listed below 3 Tulare ZIP codes 93212, 93215, , Ventura Except ZIP codes listed below 7 Ventura ZIP codes 93013, Ventura ZIP code 90265, and ZIP codes 9 beginning with 913- Yolo Except ZIP code listed below 3 Yolo ZIP code * Portions of these counties may not be in Blue s approved service area. For specific coverage area information, please contact Blue Producer Services at ProducerServices@blueshieldca.com or (800) March 2013 Monthly Rates for Individuals and Families

5 Monthly dental and dental + vision coverage rates (all regions) Specialty Duo SM dental + vision * Dental Smile SM * Dental /child $54.13 $ $ $ spouse/ domestic partner child children Please note: Monthly dues for dental plans are in addition to the dues/premiums for medical benefits covered by the Blue health plan. However, you will receive one bill that combines your health, dental and, if applicable, individual term life insurance premiums. * Underwritten by Blue of California Life & Health Insurance Company (Blue Life). Dental buy-up credit for the (all regions) If you apply for the, and would like to purchase a richer dental plan Dental, Dental, or Smile then this plan will serve as the dental component of your, replacing your Dental Plan, and reducing the rate for your by the dollar amount indicated below: /child -$3.00 child -$5.00 children -$9.00 spouse/ domestic partner -$6.00 Family -$14.00 Monthly individual term life rates (all regions) range $10,000 $30,000 $60,000* $90,000* $100,000* 1 to 18* $1.95 $2.95 N/A N/A N/A 19 to $9.25 $13.15 $ to to to * Those younger than age 19 are not eligible for $60,000, $90,000, and $100,000 benefit amounts. $90,000 and $100,000 benefit amounts are not available for new sales to those age 50 and older. These members can purchase $10,000, $30,000, and $60,000 in coverage. Existing members who purchased $90,000 or $100,000 individual term life insurance prior to age 50, and who subsequently reach age 50 are eligible to keep their original coverage until age 65. Using these rate charts The following charts show rates for all regions of the Plus,,,, Spectrum, SM and plans. Keep in mind that the rating regions for the plans differ from the rating regions for the plans. The following plans are underwritten by Blue of California Life & Health Insurance Company (Blue Life): Spectrum, Specialty Duo, Smile, and individual term life. March 2013 Monthly Rates for Individuals and Families 5

6 monthly rates for all regions 6 March 2013 Monthly Rates for Individuals and Families

7 Region 1 Monthly Rates Plans plans plans plans plans Plus plans Spectrum plans plans Plus Plus Plus child children $231 $275 $255 $274 $299 $247 $277 $323 $273 $309 $369 $316 $290 $682 $ plus one or more children March 2013 Monthly Rates for Individuals and Families 7

8 Region 2 Monthly Rates Plans plans plans plans plans Plus plans Spectrum plans plans Plus Plus Plus child children $256 $304 $281 $303 $332 $274 $306 $358 $302 $343 $408 $350 $268 $600 $ plus one or more children 8 March 2013 Monthly Rates for Individuals and Families

9 Region 3 Monthly Rates Plans plans plans plans plans Plus plans Spectrum plans plans Plus Plus Plus child children $257 $305 $281 $304 $332 $275 $307 $359 $303 $343 $409 $332 $307 $798 $ plus one or more children March 2013 Monthly Rates for Individuals and Families 9

10 Region 4 Monthly Rates Plans plans plans plans plans Plus plans Spectrum plans plans Plus Plus Plus child children $234 $278 $258 $278 $304 $250 $280 $327 $276 $314 $374 $349 $304 $673 $ plus one or more children 10 March 2013 Monthly Rates for Individuals and Families

11 Region 5 Monthly Rates Plans plans plans plans plans Plus plans Spectrum plans plans Plus Plus Plus child children $246 $292 $270 $292 $318 $262 $295 $344 $290 $330 $392 $378 $322 $750 $ plus one or more children March 2013 Monthly Rates for Individuals and Families 11

12 Region 6 Monthly Rates Plans plans plans plans plans Plus plans Spectrum plans plans Plus Plus Plus child children $280 $333 $308 $333 $363 $301 $336 $392 $331 $375 $448 $383 $340 $847 $ plus one or more children 12 March 2013 Monthly Rates for Individuals and Families

13 Region 7 Monthly Rates Plans plans plans plans plans Plus plans Spectrum plans plans Plus Plus Plus child children $227 $270 $249 $269 $294 $242 $273 $317 $268 $304 $362 $325 $268 $548 $ plus one or more children March 2013 Monthly Rates for Individuals and Families 13

14 Region 8 Monthly Rates Plans plans plans plans plans Plus plans Spectrum plans plans Plus Plus Plus child children $242 $288 $267 $288 $315 $260 $292 $340 $286 $325 $388 $354 $304 $653 $ plus one or more children 14 March 2013 Monthly Rates for Individuals and Families

15 Region 9 Monthly Rates Plans plans plans plans plans Plus plans Spectrum plans plans Plus Plus Plus child children $265 $314 $290 $314 $343 $283 $317 $370 $312 $354 $422 $389 $317 $511 $ plus one or more children March 2013 Monthly Rates for Individuals and Families 15

16 An Independent Member of the Blue Association A11710 (3/13)